Abstract White-centered, oval hemorrhages, apparently situated in the nerve-fiber layer, constitute the ocular hallmark of subacute bacterial endocarditis. They are frequently and erroneously called Roth spots. Various opinions exist regarding the morphology of these white-centered hemorrhages. In the following case, several such lesions were clinically identified and microscopically studied. Report of Case A very ill 57-year-old white woman with a petechial skin eruption was admitted to Bellevue Hospital. On the second hospital day, subacute bacterial endocarditis was diagnosed and antibiotic therapy begun. The patient failed to respond and died the following day. At autopsy, bacterial vegetations were found on the aortic and mitral valves. There were scattered organizing intravascular thrombi in many organs and the brain contained numerous microabscesses.On the second hospital day the fundi of this patient were examined, using an electric ophthalmoscope. The discs were slightly hyperemic but the margins were not blurred. White-centered elliptical hemorrhages were seen References 1. Roth, M.: Ueber Netzhautaffectionen bei Wundfiebern , Deutsch Z Chir 1:471-480, 1872.Crossref 2. Roth, M.: Beiträge zur Kenntnis der varicosen Hypertrophie der Nervenfasern , Virchow Arch Path Anat 55:197-217, 1872.Crossref 3. Litten, M.: Ueber akute maligne Endocarditis und die dabei vorkommenden Retinalveränderungen , Charité-Ann 3:135, 1878. 4. Dellmann, F.L.: Metastatische Prozesse am Auge bei Endocarditis lenta , Klin Mbl Augenheilk 63:661, 1919. 5. Krückmann, E.: Ein Beitrag zur Kenntnis der sog. Retinitis septica (Roth) , Virchow Arch Path Anat 227:227-233, 1930.Crossref 6. Doherty, W.B., and Trubek, M.: Significant Hemorrhagic Retinal Lesions in Bacterial Endocarditis (Roth's Spots) , JAMA 97:308-313, 1931.Crossref 7. Dienst, E.C., and Gartner, S.: Pathologic Changes in the Eye With Subacute Bacterial Endocarditis , Arch Ophth 31:198-206, 1944.Crossref 8. Walsh, F.B.: Clinical Neuro-Ophthalmology , ed 2, Baltimore: Williams and Wilkins Co., 1957, pp 913-914. 9. Hogan, M.J., and Zimmerman, L.: Ophthalmic Pathology: An Atlas and Textbook , Philadelphia: W. B. Saunders Co., 1962, p 486. 10. Friedenwald, J.S., and Rones, B.: Some Ocular Changes in Septicemia , Trans Amer Ophthal Soc 28:286-299, 1930.
Archives of Ophthalmology – American Medical Association
Published: Nov 1, 1965